Fever, also known as pyrexia, is defined as a body temperature above 98.6°F. It has different stages and types defined by the temperature. Fever is not a disease but a symptom caused by various bacterial, viral, parasitic and fungal infections as well as non-infectious causes. The document provides details on different fever patterns, causes, sites of infection, deleterious effects of fever and investigations. It emphasizes on supportive treatment including antipyretics, fluids, rest, diet and highlights when referral is needed based on danger signs like breathing difficulty or altered behavior.

1. FEVER

2.  Fever or pyrexia is defined as a rise in
body temperature above 98.6 degree
Fahrenheit.
 Fever is not a disease but it is a sign.
 Fever is a protective function of the
body as rise in temperature prevents
growth of pathogens.

3. Stages of fever

4. Types of fever
 Low pyrexia– when the body
temperature does not rise up to 100
degree fahrenheit than it is called as low
pyrexia.
 Moderate pyrexia– when the body
temperature remains between 100 to 103
degree fahrenheit than it is called as
moderate pyrexia.
 High pyrexia– when the body temperature
does not rise above 103-105 degree
fahrenheit than it is called as high pyrexia.
 Hyperpyrexia– when the body
temperature rises above 105 degree
fahrenheit than it is called as hyperpyrexia
or hyperthermia.

5. Types of fever
 Remittent fever : when body temperature
fluctuates more than two degree between
morning and evening but does not return to
normal.
 Patients with infective endocarditis and
rickettsial infections

 Intermittent fever– when body temperature
rises from normal to high and back to normal
at regular intervals.
 Seen in malaria, pyogenic infections,
tuberculosis, lymphomas, and septicemia.

6. Fever types Continued..
 Inverse fever: When body temperature is
highest in the morning and lowest in the
evening it is known as inverse fever.
 Hectic fever– when the difference
between high and low point of body
temperature is very high than it is called as
hectic fever
 Relapsing fever– when body temperature
becomes normal for 2-3 days than
suddenly increases again than it is known
as relapsing fever.
 Hypothermia– when the body temperature
falls bellow 95 degree fahrenheit than it is
called as hypothermia

7. Causes
 Bacterial infections
 Focal occult infections
 Classical examples would be
empyema, osteomyelitis or prostatic
infection
 Bartonella,
Coxiella and Rickettsia spp
 Enteric fever caused by
Typhoidal Salmonella
 Tuberculosis
 Brucellosis
 Yersiniosis

8. Continued..
 Parasitic infections:
 Visceral leishmaniasis and malaria
 Fungal infections:
 Histoplasma, Blastomyces, Coccidiod
es

9. Viral causes
 Adenoviruses Bronchitis, Pneumonia,
Gastroenteritis
 Herpes viruses Herpes, Chickenpox
 Parvoviruses Slapped Cheek Syndrome,
Arthritis
 Reoviruses Gastroenteritis
 Coronaviruses COVID-19, SARS,
MERS
 Togaviruses German Measles,
Encephalitis
 Orthomyxoviruses Influenza
 Rhabdoviruses Rabies
 Retroviruses AIDS and a few cancers

10. Non-infectious Causes Of Fever
Body Part Causes
Brain Cerebral Infarction/Hemorrhage, Subarachnoid
Hemorrhage.
Heart Acute MI, Pericarditis
Pulmonary Aspiration, Atelectasis, Chemical Pneumonitis
Pulmonary Embolism, ARDS
Abdomen Acalculous Cholecystitis, Ischemic Bowel, GI Bleeding,
Pancreatitis, Hepatitis, Cirrhosis, Adrenal
Insufficiency,
Vascular DVT, Thrombophlebitis, Hematoma
Cutaneous Decubitus Ulcers
Collagen vascular SLE,
Miscellaneous Drug Fever, Reaction to Radiological Contrast, Fat
Embolism, Neoplasms, Blood Transfusions, Transplant
Rejection, Gout.

12. Sites

13. Sites

14. Deleterious Effects Of
Fever
 Increase in cardiac output
 Increase oxygen consumption (10% per 1°C)
 Increase carbon dioxide production
 Maternal fever associated with foetal
malformations /or spontaneous abortion
 Poor neurological outcomes in patients with
stroke and traumatic brain injury who
manifest fever.

15. Investigation aide- When to
test, Whom to test and Which
tests..

16. • First three days--usually
investigations are not required unless
it is definitely indicated
• Uncomplicated/ not sick – Short
Febrile Illness / –no need for
investigation
• If the patient looks ‘sick’, or
has‘unusual’ symptoms at any time---
do appropriate investigation.

17. • If your area has reports of any
specific/ endemic diseases (Lepto/
Malaria/ DF/ scrub typhus)—
specifically screen for such diseases
among patients coming from such
areas

18. FEVER
• How to
control?????

19. Control of fever
• Tepid Sponging is very useful
• Paracetamol is the recommended
antipyretic .
• Common formulations are
– tablets of 500, 650 and 1000 mg,
– syrups of 120, 125, 178, and 250mg per 5 ml,
– drops of 100mg/ml.
– Suppositories of 80/170/250 mg
– In addition various ‘cold remedies’ contain
additional 150mg/ml, 125 mg/5ml or 500 mg
/tab, of paracetamol

20. • Recommended adult dose is 500-1000
mg q8h, max 4000 mg /day.
• In children, the recommended dose is
10-15 mg/ kg/dose, q4- 6 h orally.

21. • Injection Paracetamol has no clinical
superiority to oral route, and is to be
strongly discouraged, for the following
additional reasons.
• Chance of allergic reactions.
• Unsafe injection practices and needle stick
injury, risk to staff due to overloads in
injection rooms.

22. Follow up/review
when?:
• Not improving in the expected time frame
• Getting worse in spite of appropriate
treatment
• New symptoms appear-eg., rash, seizures,
altered sensorium, jaundice, reduced urine
output, etc.
• If there is a worsening on review,
immediately decide to treat/ refer up
according to the facilities available at your
institution

23. Fluids
• --Oral fluids are the safest
• ‘Home available fluid’ like kanji water, with
some added salt and lime juice is the best in all
situations except severe dehydration, and
cholera.
• Small frequent quantities may be given
repeatedly .
• This fluid type and rate of intake often reduces
the need for anti- emetics
• IV fluids only for persistent vomiting, severe
dehydration, paralytic ileus, shock, cholera, and
patient clinically too sick to consciously drink.

24. Sponging
 Use tepid water
 Increase the body
surface area being
sponged as
necessary.
 Temperature Tepid
sponge is 80 to
90°F/ or 27 to 37°C

25. Food
• No restriction, on the other hand, steady
intake of warm, soft well cooked
nutritious home available food, is to be
specifically advised
• The only advice is-‘Smaller quantity at
a time, distributed more frequently’

26. Rest
• Rest is one of the most important factors
helping recovery
• Advise rest till the patient is symptom free.
• Children should not be sent to school

27. Things not to be done in
fever management
• Use ofcovering dresses/ blankets, caps, etc,
in children as these can contribute to rapid
rise of body temperature, and febrile fits
• Food and fluid restriction
• Going to work/ school, or any exertion

28. Proper
communication to
the patients,
bystanders, public
• Fever is a symptom, and not a disease-
fear not the fever, but be careful about the
cause
• The commonest fevers are ‘viral fevers’
which do not require multiple medications
or various tests.,
• Most viral fevers take 3-5 days to
recover.
• Even paracetamol, the simplest remedy
for fevers should preferably be taken
according to the doctors advice.

29. • Supportive care is a very important part
of viral fever management both in
hospital, and at home
• These measures will help you to
improve much faster, and feel much
less fatigue after the fever comes down

30. Supportive care
includ
es
– steadyintakeofwarmoralfluidsegthickkanjiwaterwith
salt,limejuice,tender coconutwater,inpreference toblack
tea,blackcoffee,jeerawater,etc
– continuousintakeofsmallfrequentportionsofwarm,well
cookedsoft ,nutritiousfood, andlocallyavailablefruits.
– Resttilltotallysymptomfree,asitwillhelpyoutorecover
faster,andalsoprevent spreadofthefevertoothers.

31. • Donotcompelthedoctorstogiveyou injections/ivdrips
forfevertreatment, asthesearenotalwaysessential.
• Theycanalsocauseunwantedsideeffects likeshivering,
pain,dizziness,or dangerousreactions
• injectionsdonotworkfasterorbetterthanoral
paracetamol

32. hospital
after starting
treatment
– not improving in the expected time
– getting worse in spite of good treatment and
supportive care
– Onset of unusual symptoms like rash, fits,
bleeding from any site, jaundice, reduced
quantity of urine, breathing difficulty, and
altered behaviour etc.
– Not able to take food.

33. • Self medication is a dangerous habit.
• Covering the nose and mouth while
coughing or sneezing, and washing your
hands often with soap and water, will
reduce the spread of many viral fevers,
and respiratory infections to others at
home / those around you.

34. Some danger signs
in a patient with
fever
• Rash
• Fits
• Bleeding from any site
• Jaundice
• Reduced quantity of urine
• Breathing difficulty
• Altered behaviour etc.

35.  Antibiotics should not be prescribed during
strong suspicion of viral fever.
 It is important to draw two sets of blood
cultures before the start of empiric
antibiotic therapy.
 Start antibiotics for a presumed bacterial
infection promptly, but adjust the dosage
and duration, switch, or end antibiotic
therapy when results do not support or
justify the need to continue.
 Check the situation within 48 hours based
on test results and patient status.

36.  Supportive therapy with acetaminophen
(650 mg every 6 hours) is advisable,
accompanied by tepid sponging.
 It is important to avoid indiscriminate use of
antibiotic agents, nonsteroidal anti-
inflammatory drugs (NSAIDs), and steroids
in patients with AUFIs in primary care.
 Corticosteroids are not recommended in the
treatment of AUFIs.

37.  Adequate sleep, reduced stress, and
proper exercise should be ensured for
quicker recovery.
 Sufficient oral hydration (a minimum fluid
intake of 50 mL/kg of body weight in 24 hours)
should be maintained to prevent dehydration.

38.  Patients should be prescribed a soft
bland diet loaded with immune-boosting
foods, which help toughen the immune
system.
• Include foods that are easily digested and
absorbed, such as cereal and milk, soft fruits
(banana, papaya, orange), mashed khichidi,
mashed curd rice, or softly boiled veggies.
• Non vegetarian foods, deep-fried foods,
processed foods, alcohol, and tobacco should be
avoided.

39.  Redflagsignsin patientswithAUFIsindicating
theneedforhospitalization,referral,and
urgenttreatment.
 Prostration—Unabletostand,sit,orwalk
withoutsupport
 Temperature—Hyperpyrexia(temperature
>41.5°C)orhypothermia(temperature<36°C) or
rigors

40.  Respiration—Shortness ofbreath,respiratory rate>22
breaths/minute,cyanosis, arterial oxygen
saturation <92%onroomair
 Circulation: Bloodpressure<100mmHgsystolic, cold
clammyextremities, capillary refill >3 seconds
 Neurological—Altered mentalstatus(GlasgowComaScale
<13),convulsions,positive meningealsigns (suchasneck
stiffnessandKernig’ssign)

41.  Abdominal pain—Severe or persistent vomiting
 Severe conjunctival or palmar pallor
 Jaundice on examination of sclera
 Petechial or purpuric rash
 Bleeding—From nose, gums, or venipuncture sites;
hematemesis, melena

42. Thank You !!